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Old 04-09-2008, 04:47 AM   #21
Jared Buffie
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Re: Common ground...less is more

Robert,

Of course psychiatrists are going to line up and bash that article. Otherwise they would be admitting that what they do all day (push antidepressants) is bulls**t. Nobody wants to admit that.

Do you prescribe them to kids? How long do you spend with a pt before they get a script?
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Old 04-09-2008, 11:21 AM   #22
Karin Jonczak
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Re: Common ground...less is more

Quote:
Originally Posted by Jared Buffie View Post
Robert,

Of course psychiatrists are going to line up and bash that article. Otherwise they would be admitting that what they do all day (push antidepressants) is bulls**t. Nobody wants to admit that.

Do you prescribe them to kids? How long do you spend with a pt before they get a script?
Probably just as long as a cardiologist spends with their patient before prescribing something.
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Old 04-09-2008, 08:39 PM   #23
Dale Kimberlin
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Re: Common ground...less is more

Just got a new book today.

Spark: the revolutionary new science of exercise and the brain by John J. Ratey MD

very good so far.
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Old 04-11-2008, 03:08 PM   #24
Robert Pierce
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Re: Common ground...less is more

Less LDL is more? Interesting study in this week's JAMA...SANDS trial...499 American Indian men and women with diabetes but no history of heart disease. (Note that diabetes statistically puts you in a risk category similar to someone who has had a previous heart attack.) They randomized them to aggressive LDL and BP lowering (LDL of <70 and SBP of <115) and standard treatment. The endpoint for the LDL was carotid intimal medial thickness, as previously noted, a generally accepted marker for future coronary disease. The endpoint for BP was left ventricular hypertrophy. The study was not powered to detect a mortality difference. The study was funded by the National Heart, Lung, and Blood Institute.

Compared to baseline, CIMT regressed in the aggressive treatment group and progressed in the standard treatment group (p<.001). Left ventricular mass decreased more in the aggressive treatment group (p=.03).

Of course, this doesn't settle anything. The accompanying editorial is titled: "The Great Debate of 2008 - How Low to Go in Preventive Cardiology"

wfs: http://jama.ama-assn.org/cgi/content/short/299/14/1678
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Old 04-11-2008, 08:31 PM   #25
David Wood
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Re: Common ground...less is more

Quote:
Originally Posted by Jared Buffie View Post
Robert,

Of course psychiatrists are going to line up and bash that article. Otherwise they would be admitting that what they do all day (push antidepressants) is bulls**t. Nobody wants to admit that.

Do you prescribe them to kids? How long do you spend with a pt before they get a script?

Jared: Would you be willing to respond to the criticisms raised by the article (the message), instead of making an ad hominem attack on the messenger?
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Old 04-12-2008, 11:58 AM   #26
Jared Buffie
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Re: Common ground...less is more

David,

There was no attack in my message. Simply an observation on the lack of objectivity in the comments to my post that Robert steered me to. It was in no way directed at him personally, and I thought I was clear on that. Robert is a GP I believe, and not a psychiatrist.
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Old 04-12-2008, 07:37 PM   #27
David Wood
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Re: Common ground...less is more

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Originally Posted by Jared Buffie View Post
David,

There was no attack in my message. Simply an observation on the lack of objectivity in the comments to my post that Robert steered me to. It was in no way directed at him personally, and I thought I was clear on that. Robert is a GP I believe, and not a psychiatrist.

. . . if you say so. Sounded like an attack to me, particularly the part about "how much time do you spend with your patients". My guess (without meaning to speak for him) is that he spends us much time as a screwed-up health economics situation will let him.


However, he wasn't the only "messenger" that I was referring to. The link he posted was to a review (by a psychiatrist, yes) of the article you posted. That review raised certain challenges to the methods of the study you posted: specifically, that the drugs studied were all relatively old (that may be all that was available with enough studies to review), with the implication that newer (better?) drugs might have shown different results, and that the studies were all short term (6 - 8 weeks), where the reviewer claimed clinical experience that suggested periods at least twice that long were needed to see significant improvement.

Interesting points. Your response was to attack the reviewer (I guess you didn't mean to include Robert) for being a psychiatrist, declaring him incapable of being objective.

Unfortunately, the challenges raised stand on their own, despite the person who raised them. I was wondering if you would respond to those, rather than attacking the reviewer for the terrible act of actually being involved in patient care.
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Old 04-12-2008, 07:59 PM   #28
David Wood
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Re: Common ground...less is more

I'm also curious why this topic (the use of anti-depressants) brings out such emotion?

I'm personally not a fan of "maintenance meds" of any kind for myself, particularly for maladies that can be fixed by exercise, better diet, and mental work. Blessedly, through some combination of genetics, CrossFit, and semi-Zone/Paleo eating, I enjoy pretty good health. But I wouldn't hesitate to take an SSRI (or other psychoactive drug) if I felt I would benefit from it, and if my efforts via non-pharmaceutical means weren't doing enough for me (on whatever "front" I was trying to improve).

There would be risks of unwanted effects (the list posted above for Effexor). If any of those showed up in my case specifically, I'd be the one to judge whether the desired effects I was getting (if any) were worth the negative effects.

FWIW, there are any number of herbal and other approaches to "mental management" that you can buy in a health-food store (I've tried many of them). Some of these proved profoundly useful to me at a time of serious emotional "crisis" (loss of three family members in violent ways in less than 3 months). Others, not so useful.

I'm under no illusion that these were/are any less "drugs" than a pure SSRI that I might get from a pharmacy . . . they're just sourced differently. And these "natural" approaches have just as many "other effects" (some of them desirable, some of them not) and contraindications as the big pharma product. It's "buyer beware" all the way around.


What I'm having trouble understanding why it irritates anyone (particularly some posters in this thread) that someone else (me, in this example) chooses to manage their "lifestyle problems" (be it depression, or high blood pressure, or diabetes, or whatever) with meds instead of your/our preferred option (diet and exercise).

No, it's not my choice, either, but how does it harm anyone else? Why the (apparent) anger toward them?



Also FWIW, I would generally support total "freedom of prescription" for pretty much any class of drugs that's not an opiate, soporific, or hallucinogenic (interferes too much with driving, which could put other people at risk). I figure we could raise our societal IQ by 10 or 20 points within a generation.

Last edited by David Wood : 04-12-2008 at 08:42 PM.
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Old 04-13-2008, 05:17 AM   #29
Robert Pierce
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Re: Common ground...less is more

Quote:
How long do you spend with a pt before they get a script?
I was going to say, "Long enough to make a diagnosis, review the treatment options and their costs, side effects, and effectiveness" which, while true, just sounded too darn defensive. David, I like your answer much better!

Quote:
No, it's not my choice, either, but how does it harm anyone else? Why the (apparent) anger toward them?
I will offer a reply, and that is that it reinforces the culture of the prescription answer for the problem. This could be seen as harmful on a societal level in a number of ways, such as antibiotic resistance from overuse of antibiotics and increases in health care costs.

Quote:
...screwed-up health economics situation...
You got that right, don't get me started...a topic for another thread, maybe.

Last edited by Robert Pierce : 04-13-2008 at 05:17 AM. Reason: typo
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Old 04-13-2008, 09:51 AM   #30
Jared Buffie
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Re: Common ground...less is more

Well, here's the easy answer:

"two of them aren't SSRIs" - I guess that means that two of them are. Despite the small variations, they all function in the same way - by blocking nerves endings from reabsorbing seratonin, therefore raising levels in the brain.

"they are old and not often prescribed"

1. It's because the patents have worn off and drug companies send their reps into psychiatrists offices pushing newer, more expensive "on patent" meds. Gwen Olsen talks about this in her book "Confessions of an Rx Drug Pusher". As a matter of fact, there's evidence that the newer SSRI's actually perform WORSE than the older ones (that's off the top of my head and I'm not spending my Sunday looking for a source).

We could start talking about PHARMA, this seems like a good place to do it. Remember, in the end, for drug companies it's all about $$$$$. That means that the newest designer drug is to be pushed over the older generic at all cost. It's funny how the old drugs are bashed in order to sell the new ones, despite the fact that they were heralded at the greatest things when they were on patent.

The only reason I asked about the time with patients and prescribing to kids was out of curiosity. Only one drug has been approved for kids under 18, yet others are prescribed "off label" to kids all the time. In fact, 6% of children are on antidepressants.

The medical establishment takes pride in being evidence based, yet the majority of scripts are off label, meaning there have never been studies to prove that the drugs given are safe and/or effective for the condition/patient they were given to. A classic example of that is antidepressants in kids.
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